Audit 408927

Federal Agency: U.S Department of Health and Human Services Federal Program Name: Health Center Program Cluster Assistance Listing Number: 93.224 Award Period: 1/1/2025 – 12/31/2026 Type of Finding: Significant Deficiency in Internal Control over Compliance and Compliance Criteria or specific requirement: Under the compliance requirement for Special Tests and Provisions for ALN 93.224, “health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay”. Condition: Encounters eligible for a sliding fee adjustment did not receive the appropriate adjustment per the patient’s approved sliding fee discount level. Context: During our testing of sliding fee discounts for health center patients qualifying for reduced charge visits, we identified three visits in a sample of forty, which received the incorrect sliding fee discount. Cause: Internal control process and procedures were not followed resulting in a discount applied in the billing system that did not match the sliding fee determination per the approved patient application. Effect: Patient would receive an incorrect sliding fee discount. Recommendation: We recommend implementation of a second level independent review of the demographic data and income verification information entered into the patient billing system in order to ensure the financial classification is correct. Views of responsible officials: There is no disagreement with the audit finding.